RUXTON TOWERS

EYE ASSOCIATES

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L & S Optical Frames Selection

FIND FRAMES YOU LIKE AND WE'LL ORDER THEM FOR YOU TO TRY ON!
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REQUEST AN APPOINTMENT

Please print and complete these registration and health forms, and bring these forms with you at the time of your visit. Thank you.

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L & S Optical

EYE PROBLEMS?

OUR OFFICE PHOTO ALBUM

RUXTON TOWERS EYE ASSOCIATES

Contact Lens Order Form

Your First and Last name: (required)

Address:

City:

State:

Zip:

Telephone number where we can reach you to verify this order: (required)

Email address: *

Contact Lens Information: (required)

Right Eye

Manufacturer:

Power:

Left Eye

Manufacturer:

Power:

Or We have your information and you want to reorder same as last time (Yes or No):

Special Instructions:

All information that you provide is kept strictly confidential. This form is only for your convenience and may not be secure from hackers. If you are concerned about your privacy, please do not use this form to order your contact lenses. You can instead call our office at 410-828-9270 to place your order. If you do choose to use this form to order your contacts, certainly do not provide any credit card information on it. We will call you to verify your order and obtain payment information at that time.

HOME
ABOUT US
EYE EXAMS
LASERS/SURGERY
CONTACTS
EYEGLASSES
DIRECTIONS

RUXTON TOWERS EYE ASSOCIATES

Appointment Request or Question Form

All information that you provide is kept strictly confidential. Please provide the following information and a RTEA staff member will contact you to schedule an appointment. Thank you.

Your First and Last name:

Address:

City:

State:

Zip:

Phone:

Email address

Comments:

Please print and complete these registration and health forms, and bring these forms with you at the time of your visit. Thank you.